Pediatric Vomiting/Diarrhea/Dehydration



Pediatric Vomiting/Diarrhea/Dehydration

| |

|Date and time: |Name: |

| |Age: |

|Allergies: NKMA |DOB: |

|1. Admit to: [ ] Acute Care [ X ] Day Bed [ ] SCUnit [ ] Telemetry |

|2. Attending Dr: Younger |

|3. Admitting Dx: Pediatric vomiting/diarrhea (gastroenteritis). |

|4. Contributing Dx: mild dehydration |

|5. Condition: |[ X ] Stable [ ] Fair [ ] Serious [ ] Critical |

|6. VS: |Qid. Weight on admission and each AM. |

|7. Activity: |Up in room as tolerated. |

|8. Nursing: |Strict I/Os; daily weight. |

|9. Diet: |Use Pedialyte or Pedialyte Popsicles until she has gone 6 hours without vomiting, and then may try a diet as |

| |tolerated. |

|10. IV: |Estimate % dehydration: |

| |Mild = 5% = decreased tearing. |

| |Moderate = 7% = dry mouth. |

| |Severe = 10% = skin tents. |

| | |

| |Replacement (MLS) = % x weight (kg): |

| |Replace 1/3 over first 4 hr with D5 normal saline. |

| |Replace 1/3 over second 8 hr with D5 normal saline. |

| |Replace 1/3 over third 12 hr with D 5 normal saline. |

| |Replace in addition to maintenance: |

| | |

| |Maintenance = 100 mL/kg/day up to 10 kg; 50 mL/kg/day between 10-20 kg; 20 mL/kg/day over 20 kg. |

| | |

| |1.Restoration of vascular volume: |

| |IV bolus of 20 ml/kg or ___ ml of NS over ½ hour. |

| | |

| |2.Next 8 hours-Partial restoration of fluid deficit: |

| |1/3 maintenance fluids and ½ deficit fluids. |

| | |

| |3.Next 16 hours-Finish restoration of fluid deficit: |

| |2/3 maintenance fluids and ½ deficit fluids. |

| | |

| |Replace losses with LR or NS. |

| |For maintenance fluids: |

| |Infants: D5 ¼ NS |

| |Toddlers/Children: D5 ¼ NS |

| | |

| |Fluid bolus of 400 ml IV NS over one hour, followed by D5 ¼ NS IV at 120 ml/hr for 8 hours, and then decrease |

| |the IV rate to 90 ml/hr for 16 hours, followed by a maintenance rate of 60 ml/hr. After the fluid bolus has |

| |been given, please add 2 mEq of KCl per 100 ml of IV fluid. |

|11. Meds: |Tylenol 80 mg chewable tablets, 1 and ½ tablets by mouth every 4 hours as needed for T > 101(F. |

| |Zofran 2 mg IV every 4 hours as needed for nausea or vomiting. |

|12. Other Meds: | |

|13. Consultants: |None. |

|14. Labs: |Chem 7, CBC, UA on admission; chem-7 tomorrow AM; stool for rotavirus testing, routine culture, giardiasis |

| |antigen, WBC stain, and occult blood. |

|15. H&P: |Please type up the H&P. |

| | |

| |signed______________________________________________ |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download